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Aggression in Autism

Categories: | Author: Matt O'Leary | Posted: 7/14/2014 | Views: 1507

A discussion about autism and aggressive behaviors through the lens of Matt's theory.

Tara asked for a discussion about aggression and autism. Aggression is a behavior frequently seen in autism, particularly in teenage boys. According to my theory, the reason for this is largely due to how the male stress response works. Again, according to my theory, autism is a disorder that starts with an abnormally excitatory nervous system, which, due to problems caused with filtering information from the outside world, results in chronic stress response activation. A reinforcing feedback loop is generated: start with too much brain excitation, proceed to too much information flow into the brain causing the brain to view neutral stimuli as threats, proceed to high levels of stress response activation, which feeds back onto the brain and further pushes the brain into excitatory imbalance, and so on down the vicious spiral. 

 

Many autistic behaviors and deficits result from these impacts upon the human stress response, including, I believe, aggression. The male stress response is different than the female version (though some men have stress responses more like women and vice versa). The male stress response is called the “fight or flight” response. Under stress, men tend to either withdraw (fly) from the stressor or attack (fight), with withdrawal being the normal, human, male response in modern society. However, for an autistic boy, in a world filled with incessant threats that cannot be ignored (not really threats but that is how their brain responds), in a mind that lacks a full understanding of the societal rules of behavior, fight (aggression) becomes a much more likely response. This is particularly so during teenage years, when the biological stress of puberty (further stoking the vicious spiral) combined with high levels of testosterone, makes aggression a much more frequent occurrence.


So, what do you as a parent of a 13 year old, or a 5 year old, do about aggression in autistic boys (or girls, as some girls share many male stress response characteristics)?

 

First, try to identify a pattern associated with aggressive behavior. What external stimulus or characteristic, like time of day, excessive noise, long car ride, particular type of clothing, etc… can be associated with the aggressive behavior? Try keeping a journal as you try to identify a pattern that sets off the fight response. If you can identify a stimulus, try to avoid, remove, or attenuate the stimulus.

 

Second, humans have strongly activating stress responses because they were necessary to survival in earlier centuries / millenia – the stress response is our threat spotting and physical mobilizing system, to make sure we identify and can deal with potential threats in our environment. In the modern world, with many fewer daily external threats, the stress response can be a major liability, particularly in boys who get stuck in a reinforcing feedback loop that they cannot easily break. The way that humans generally deal with a highly reactive stress response is through “coping”. The good kind of coping is called “adaptive coping” and helps people achieve happiness and calmness – for the average person, adaptive coping includes things like exercise, good sleep habits, quiet time, hugs, and time spent outdoors. The bad kind of coping is called “maladaptive coping”, coping that may make you feel better in the moment but over time degrades the capacity of the person to thrive. Maladaptive coping often includes alcohol abuse, social withdrawal, family violence and withdrawal into video games (especially in males).

 

Adaptive coping is the key to long term stress response management. Adaptive coping helps keep people resilient, able to withstand and deal with day to day difficulties. It (exercise in particular) is how I stay functional, as a person on the very high functioning side of the autism spectrum who tries to stay thoroughly engaged in the world, with my job, family, etc… And, from my perspective, it is a crucial component of managing the care of a child on the autism spectrum, particularly those showing aggressive behaviors indicating stress response overload. I have an extensive section on Coping with Autism elsewhere on this website. I really recommend studying it and using it – I know it sounds a little hoaky in our modern, short sighted, pill based society, but this is truly important stuff for dealing with an aggressive child.

 

In particular, I recommend exercise as a one fits all adaptive coping strategy. It is my strategy and it is the key to my ability to function. I took a 1.5 hour bike ride this evening and that is why I am currently at work writing this email. I have a friend who has a moderately autistic daughter who is about 25 now. Her daughter regressed severely during puberty and turned very aggressive. My friend struggled to deal with her as she was quite large at the time and extremely strong. By the time her daughter hit the late teen years, my friend was seriously considering institutionalizing her daughter as she simply couldn’t handle her anymore. For whatever reason (this was before I met my friend), my friend got a treadmill and eventually had her daughter walking 45 minutes a day, every day. This turned things around for this family. Today, my friend’s daughter lives in a supportive care environment and works 5 hours a day for my friend’s employer, and is universally loved. She still spends 45 minutes every day on the treadmill.

 

Third, I strongly recommend limiting or eliminating access to television, the internet, and in particular video games (whether aggressive or not). Video games in particular are a male, maladaptive coping strategy that may, in the moment, make the male feel powerful and in control, but over time result in decreased resilience and greater problems with stress response activation. Playing video games for long periods of time, which I have done at times in my life, results in a visual exposure that tends to increase neural excitation (bad), in a lack of exercise and physical movement that would decrease stress response activation (bad), in being trapped indoors for long periods of time (bad), and, in violent video games, the perception by the brain or large numbers of threats (which are real as far as the brain knows) (really bad).

 

Finally, I would recommend being very, very careful about resorting to medication, particularly long term medication. Almost all of the psychotropic medications do the same thing – they decrease neural excitation in the brain, though in a variety of different ways. And, all suffer from the same basic problem – tolerance (i.e. you need to drink more beer to get the same buzz). This is the same problem pain medications like oxycontin have that result in them being gateways into heroin – as your body builds up tolerance, you need more to get the same effect, and eventually, you can’t afford those doses and look for the cheaper alternative. I am not saying putting your child on an SSRI is going to cause them to become a heroin addict. But, long term medication will result in tolerance (for nerds out there, because of the impact upon post-synaptic receptor density associated with a changed signal across the neural synapse), resulting in needing more medication to get the same effect, and so on down the vicious spiral. As dosage increases, problems also increase. The other problem with medications is they make us stupid – while relying upon the medication which is not a long term solution, we stop looking for the real solution (adaptive coping).


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